Provider Demographics
NPI:1386758423
Name:PREMIER ORTHOPAEDICS &SPORTS MEDICINE,PC
Entity type:Organization
Organization Name:PREMIER ORTHOPAEDICS &SPORTS MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-833-9500
Mailing Address - Street 1:111 GALWAY PL
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3606
Mailing Address - Country:US
Mailing Address - Phone:201-833-9500
Mailing Address - Fax:201-862-0095
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-943-9100
Practice Address - Fax:201-943-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ032216Medicare ID - Type Unspecified